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Nursing students' perceptions of learning in community -based clinical settings

Abstract

The focus of health care in the 1990's has shifted from the traditional acute care hospital setting to non-traditional community settings. This study examined what students perceive as the nature of learning in community-based clinical settings and what variables students identify that contribute to or are barriers to learning in the community. An ethnographic design was employed in an attempt to understand the culture of student learning in community-based settings. Semi-structured interviews (N = 15) and observational visits were conducted with senior-level baccalaureate students enrolled in the Community Health Nursing course in a small, private college in the Mid-Atlantic region. ^ Data analysis searched for the themes of the students' culture of learning. Four major themes emerged from the analysis: independence, clinical skills, the preceptor, and the clinical site. Students reported that becoming independent and confident in their nursing practice and developing their clinical skills constituted the nature of learning in community-based settings. However, students described the refinement of previously learned clinical skills but for the most part did not have the opportunity to learn and practice advanced clinical skills that they hoped would be available. The role of the preceptor and the clinical site were seen as both contributing to and impeding learning in the community. Students who reported positive learning experiences described preceptors who were positive role models and clinical sites that gave them the opportunity to grow and develop. Students who reported negative learning experiences described preceptors who were disinterested, incompetent professionals and clinical sites where they were unable to practice independently. These themes have implications for the future of nursing education and the profession of nursing. Recommendations for changes in community health nursing, nursing education, and nursing research are identified. While this study provides an understanding of the nature of student learning in the community and the variables that give meaning to the learning, the sample size is small and no generalizations should be made.^